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Recker F, Remmersmann L, Jost E, Jimenez-Cruz J, Haverkamp N, Gembruch U, Strizek B, Schäfer VS. Development of a 3D-printed nuchal translucency model: a pilot study for prenatal ultrasound training. Arch Gynecol Obstet 2024:10.1007/s00404-024-07561-8. [PMID: 38796557 DOI: 10.1007/s00404-024-07561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND We used two 3D ultrasound volumes of fetal heads at 13 weeks to create live-size 3D-printed phantoms with a view to training or assessment of diagnostic abilities for normal and abnormal nuchal translucency measurements. The phantoms are suitable for use in a water bath, imitating a real-life exam. They were then used to study measurement accuracy and reproducibility in examiners of different skill levels. METHODS Ultrasound scans of a 13 + 0-week fetus were processed using 3D Slicer software, producing a stereolithography file for 3D printing. The model, crafted in Autodesk Fusion360™, adhered to FMF guidelines for NT dimensions (NT 2.3 mm). Additionally, a model with pathologic NT was designed (NT 4.2 mm). Printing was performed via Formlabs Form 3® printer using High Temp Resin V2. The externally identical looking 3D models were embedded in water-filled condoms for ultrasound examination. Eight specialists of varying expertise levels conducted five NT measurements for each model, classifying them in physiological and abnormal models. RESULTS Classification of the models in physiological or abnormal NT resulted in a detection rate of 100%. Average measurements for the normal NT model and the increased NT model were 2.27 mm (SD ± 0.38) and 4.165 mm (SD ± 0.51), respectively. The interrater reliability was calculated via the intraclass correlation coefficient (ICC) which yielded a result of 0.883, indicating robust agreement between the raters. Cost-effectiveness analysis demonstrated the economical nature of the 3D printing process. DISCUSSION This study underscores the potential of 3D printed fetal models for enhancing ultrasound training through high inter-rater reliability, consistency across different expert levels, and cost-effectiveness. Limitations, including population variability and direct translation to clinical outcomes, warrant further exploration. The study contributes to ongoing discussions on integrating innovative technologies into medical education, offering a practical and economical method to acquire, refine and revise diagnostic skills in prenatal ultrasound. Future research should explore broader applications and long-term economic implications, paving the way for transformative advancements in medical training and practice.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Laura Remmersmann
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Elena Jost
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Jorge Jimenez-Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Nicolas Haverkamp
- Office of Academic Affairs, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Valentin S Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
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Montaguti E, Diglio J, Petrachi B, Arosio V, Fiorentini M, Cavalera M, Pellegrino A, Amodeo S, Lenzi J, Pilu G. Identification of Fetuses at Increased Risk of Trisomies in the First Trimester Using Axial Planes. Fetal Diagn Ther 2023; 51:1-6. [PMID: 37778343 DOI: 10.1159/000533879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The measurement of nuchal translucency (NT) is crucial for assessing risk of aneuploidies in the first trimester. We investigate the ability of NT assessed by a transverse view of the fetal head to detect fetuses at increased risk of common aneuploidies at 11-13 weeks of gestation. METHODS We enrolled a nonconsecutive series of women who attended our outpatient clinic from January 2020 to April 2021 for aneuploidy screening by means of a first trimester combined test. All women were examined by operators certified by the Fetal Medicine Foundation. In each patient, NT measurements were obtained both from the median sagittal view and transverse view. We calculated the risk of aneuploidy using NT measurements obtained both with sagittal and axial scans, and then we compared the results. RESULTS A total of 1,023 women were enrolled. An excellent correlation was found between sagittal and transverse NT measurements. The sensitivity and specificity of the axial scan to identify fetuses that were deemed at risk of trisomy 21 using standard sagittal scans were 40/40 = 100.0% (95% confidence interval [CI]: 91.2-100.0) and 977/983 = 99.4% (95% CI: 98.7-99.7), respectively. The sensitivity and specificity of the axial scan to identify fetuses at risk of trisomy 13 or 18 were 16/16 = 100.0% (95% CI: 80.6-100.0) and 1,005/1,007 = 99.8% (95% CI: 99.3-99.9). CONCLUSIONS When the sonogram, a part of combined test screening, is performed by an expert sonologist, axial views can reliably identify fetuses at increased risk of trisomies without an increase in false negative results.
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Affiliation(s)
- Elisa Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Josefina Diglio
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Petrachi
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Viola Arosio
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marta Fiorentini
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marta Cavalera
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anita Pellegrino
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Amodeo
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Labadini C, Lohmann L, Ville Y, Quarello E. Monochorionic twins with discordant trisomy 21, another case to remind this uncommon condition and how to deal with. J Gynecol Obstet Hum Reprod 2023; 52:102620. [PMID: 37295772 DOI: 10.1016/j.jogoh.2023.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/09/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
Monozygotic twins discordant for trisomy 21 are rare. We present the twelfth reported case of this uncommon condition undergoing invasive prenatal diagnosis. Dealing with discordant fetal anomalies in monochorionic pregnancy can be challenging for physicians and patients; pros and cons of different invasive procedure options must be discussed with the couple, contending with certain specific peculiarities of this type of pregnancy. Although chorionic villi sampling can be performed earlier, higher risk of misdiagnosis of discordant aneuploidy is reported. Indeed, when heterokaryotic twins are suspected, a two-sampling amniocentesis is recommended, to ensure independent sampling of each fetus and to rule out confined placental mosaicism as well. The couple should be informed of the possible management and the risks for the non-affected twin whether selective reduction is required, and likewise if the pregnancy continues without selective termination.
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Affiliation(s)
- Corinne Labadini
- Institut méditerranéen d'imagerie médicale appliquée à la gynécologie, la grossesse et l'enfance IMAGE(2), 6 Rue Rocca, 13008 Marseille, France; Unité de dépistage et de diagnostic prénatal, Hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex, France; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | | | - Yves Ville
- Department of Obstetrics and Fetal Medicine, APHP Necker-Enfants Malades University Hospital, 75015 Paris, France
| | - Edwin Quarello
- Institut méditerranéen d'imagerie médicale appliquée à la gynécologie, la grossesse et l'enfance IMAGE(2), 6 Rue Rocca, 13008 Marseille, France; Unité de dépistage et de diagnostic prénatal, Hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex, France.
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4
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Zhang H, Wang S, Feng C, Zhao H, Zhang W, Sun Y, Yang H. Chromosomal abnormalities and structural defects in fetuses with increased nuchal translucency at a Chinese tertiary medical center. Front Med (Lausanne) 2023; 10:1158554. [PMID: 37287743 PMCID: PMC10243215 DOI: 10.3389/fmed.2023.1158554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives To explore the pregnancy outcomes of fetuses with increased NT thickness. Methods This was a retrospective study of fetuses with increased NT (≥95th centile) at 11-14 weeks of gestation between January 2020 and November 2020. Results Among 264 fetuses with increased NT, the median of CRL and NT was 61.2 mm and 2.41 mm. Among them, 132 pregnancy women chose invasive prenatal diagnosis (43 cases of chorionic villus sampling (CVS), 89 cases of amniocentesis). Eventually, 16 cases of chromosomal abnormalities were discovered, including 6 cases (6.4%) of trisomy 21, 4 cases (3%) of trisomy 18, 1 case (0.8%) of 45, XO, 1 case (0.8%) of 47, XXY and 4 cases (3.03%) of CNV abnormalities. The major structural defects included hydrops (6.4%), cardiac defects (3%), and urinary anomalies (2.7%). The incidences of chromosomal abnormalities and structural defects in the NT < 2.5 mm group were 1.3 and 6%, while the incidences were 8.8 and 28.9% in the NT≥2.5 group. Conclusion Increased NT was associated with high risk of chromosomal abnormalities and structural anomalies. Chromosomal abnormalities and structural defects could be detected when NT thickness was between 95th centile and 2.5 mm.
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Affiliation(s)
- Huijing Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Shuang Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Chunli Feng
- Department of Ultrasound, Tongliao Second People’s Hospital, Tongliao, Inner Mongolia, China
| | - Hongyan Zhao
- Department of Obstetrics and Gynecology, Chengde Central Hospital, Chengde, Hebei, China
| | - Weiwei Zhang
- Department of Ultrasound, Aerospace Central Hospital, Beijing, China
| | - Yu Sun
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Invasive diagnosis after first-trimester aneuploidy screening. Am J Obstet Gynecol 2022; 227:928. [PMID: 35863461 DOI: 10.1016/j.ajog.2022.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 01/26/2023]
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Muacevic A, Adler JR, Lone Z, Agrawal S, Nayak P, Pati SK. Effect of Exogenous Progesterone on Fetal Nuchal Translucency: An Observational Study. Cureus 2022; 14:e33023. [PMID: 36721559 PMCID: PMC9883054 DOI: 10.7759/cureus.33023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Nuchal translucency is a reliable first trimester screening test for fetal structural and chromosomal defects. Neonates with increased nuchal thickness are at greater risk for anomalies. Exogenous progesterone supplementation may affect nuchal translucency and thus the first trimester anomaly screening. We aimed to study if there was a difference in nuchal thickness between women receiving progesterone in the first trimester compared to those who were not supplemented with progesterone. Material and methods Forty-seven women with documented progesterone intake in the first trimester for at least 10 continuous days before the day of the nuchal translucency scan served as the study group compared to 47 other women who did not receive progesterone. Nuchal translucency was measured between 11 and 13 weeks and six days of gestation. Results The mean nuchal translucency increased with increasing gestation in both groups. Maximum mean nuchal translucency was greatest in the age group 18-20 years (1.35 + 0.1 millimeters) in women receiving progesterone compared to 36-40 years (1.65 + 0.49 millimeters) in controls. The mean nuchal translucency in women receiving progesterone was 1.15 + 0.26 millimeters, and in those that did not receive progesterone, it was 1.23 + 0.35 millimeters (p = 0.314). Conclusions Nuchal translucency increased with increasing gestation in both groups, irrespective of progesterone supplementation. There was no significant difference in mean nuchal translucency in women supplemented with progesterone compared to those that did not receive progesterone in the first trimester.
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Montaguti E, Rizzo R, Diglio J, Di Donna G, Brunelli E, Cofano M, Seidenari A, Lenzi J, Battaglia C, Pilu G. Increased nuchal translucency can be ascertained using transverse planes. Am J Obstet Gynecol 2022; 227:750.e1-750.e6. [PMID: 35662633 DOI: 10.1016/j.ajog.2022.05.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The detection of increased nuchal translucency is crucial for the assessment risk of aneuploidies and other fetal anomalies. OBJECTIVE This study aimed to investigate the ability of a transverse view of the fetal head to detect increased fetal nuchal translucency at 11 to 13 weeks of gestation. STUDY DESIGN This was a prospective study enrolling a nonconsecutive series of women who attended our outpatient clinic from January 2020 to April 2021 for combined screening and were examined by operators certified by the Fetal Medicine Foundation. In each patient, nuchal translucency measurements were obtained both from a median sagittal view and from a transverse view. A second sonologist blinded to the results of the first examination obtained another measurement to assess intermethod and interobsever reproducibility. RESULTS A total of 1023 women were enrolled. An excellent correlation was found between sagittal and transverse nuchal translucency measurements, with a mean difference of 0.01 mm (95% confidence interval, -0.01 to 0.02). No systematic difference was found between the 2 techniques. The inter-rater reliability (intraclass correlation coefficient, 0.957; 95% confidence interval, 0.892-0.983) and intrarater reliability (intraclass correlation coefficient, 0.976; 95% confidence interval, 0.941-0.990) of axial measurements were almost perfect. Transverse measurements of 3.0 mm identified all cases with sagittal measurements of ≥3.0 with a specificity of 99.7%; transverse measurements of >3.2 mm identified all cases with sagittal measurements of 3.5 mm with a specificity of 99.7%. The time required to obtain transverse nuchal translucency measurements was considerably shorter than for sagittal measurements, particularly when the fetus had an unfavorable position. CONCLUSION When the sonogram is performed by an expert sonologist, the difference in nuchal translucency measurement obtained with a transverse or sagittal plane is minimal. Increased nuchal translucency can be reliably identified by using transverse views, and in some cases, this may technically be advantageous.
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Affiliation(s)
- Elisa Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Roberta Rizzo
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Josefina Diglio
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gaetana Di Donna
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Brunelli
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Cofano
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Seidenari
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Cesare Battaglia
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Strauss TS, Dutton A, Cary C, Boniferro E, Stoffels G, Feldman K, Hussain F, Ashmead G, Al-Ibraheemi Z, Brustman L. The role of the first trimester screen in the face of normal cell free DNA. J Matern Fetal Neonatal Med 2022; 35:9907-9912. [PMID: 35603424 DOI: 10.1080/14767058.2022.2075695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE There is no consensus for the method of aneuploidy screening in pregnancy. Cell free DNA (cfDNA) is the most sensitive screen for trisomies 21, 13, and 18, however the first trimester screen (FTS) is a marker for other adverse outcomes, such as structural anomalies, growth restriction, and preeclampsia. In 2019, we offered FTS (nuchal translucency (NT) and analytes) with or without cfDNA. The purpose of this study was to assess clinical relevance of abnormal FTS in women with normal cfDNA. METHODS We retrospectively reviewed women undergoing screening in our Fetal Evaluation Unit in 2019. Women included had normal cfDNA and abnormal FTS; consisting of NT >95%, PAPP-A < 0.4 MoM, beta-HCG >2.5 MoM, or overall increased risk of trisomies. RESULTS 195 patients had abnormal FTS and normal cfDNA. 41 (21%) had adverse maternal outcomes including hypertension, abnormal placentation, and placental abruption. 34 (17%) had adverse fetal outcomes including growth restriction, structural anomalies, fetal demise, polyhydramnios, previable PPROM, necrotizing enterocolitis after a preterm birth, and a balanced translocation. CONCLUSION Abnormal FTS predicts adverse outcomes in 33% of women with normal cfDNA. Our data suggests that offering universal FTS with cfDNA may have clinical benefit.
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Affiliation(s)
- Tirtza Spiegel Strauss
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alana Dutton
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Cary
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Boniferro
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guillaume Stoffels
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristina Feldman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Farrah Hussain
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Graham Ashmead
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zainab Al-Ibraheemi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lois Brustman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Narava S, Balbir Singh S, Barpanda S, Bricker L. Outcome of pregnancies with first-trimester increased nuchal translucency and cystic hygroma in a tertiary maternity hospital in United Arab Emirates. Int J Gynaecol Obstet 2022; 159:841-849. [PMID: 35435254 DOI: 10.1002/ijgo.14222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To study the outcome of pregnancies with first-trimester increased nuchal translucency and cystic hygromas. METHODOLOGY Retrospective study of 132 pregnancies with first-trimester increased nuchal translucency and cystic hygromas, between January 2015 to December 2018 at Corniche Hospital, Abu Dhabi, UAE. Fetal karyotyping, detailed ultrasound at 18-22 weeks and fetal echocardiography were offered to all women. Adverse outcomes included miscarriage, intrauterine fetal death, termination of pregnancy, neonatal death and structural abnormalities. RESULTS Of the 132 pregnancies, 13 had NT > 95th percentile, 89 had NT ≥3 mm and 30 had cystic hygroma. Among 13 pregnancies with NT > 95th centile, 7.6% had abnormal karyotype. Among 89 pregnancies with NT ≥3 mm, 29.2% had abnormal karyotype, 13.4% miscarriage, 7.8% underwent TOP, 5.6% intrauterine fetal death, 1.1% neonatal death and 14.6% had structural abnormalities. Among 30 pregnancies with cystic hygroma, 40% had abnormal karyotype, 20% miscarriage, 13.3% TOP, 13.3% intrauterine fetal death, 6.6% had neonatal death and 20% had structural abnormalities. CONCLUSION In our study, karyotype abnormalities increased with increasing nuchal translucency with highest risk in fetuses with cystic hygromas. Increased nuchal translucency was associated with adverse pregnancy outcome, which was higher in the group with NT≥6 mm and cystic hygromas.
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Affiliation(s)
- Sumalatha Narava
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Sushma Balbir Singh
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Samikshyamani Barpanda
- Department of Obstetrics and Gynaecology, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Leanne Bricker
- Fetal Medicine Department, Corniche Hospital, Abu Dhabi, United Arab Emirates
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Doulaveris G, Igel CM, Estrada Trejo F, Fiorentino D, Rabin-Havt S, Klugman S, Dar P. Impact of introducing cell-free DNA screening into clinical care on first trimester ultrasound. Prenat Diagn 2022; 42:254-259. [PMID: 34989002 DOI: 10.1002/pd.6086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/07/2021] [Accepted: 12/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE First-trimester ultrasound is an important component of prenatal care. We investigated the impact of introducing cell-free DNA (cfDNA) aneuploidy screening into routine care, on performance of first-trimester ultrasound. METHODS Retrospective study of patients who had prenatal care at a tertiary referral center. We compared the performance of any first-trimester ultrasound between three different aneuploidy screening protocols, used consecutively during the study period: (1) combined first-trimester screening (FTS); (2) FTS and cfDNA offered together; (3) patients requested to choose between FTS and cfDNA. Secondary outcomes included performance of nuchal translucency (NT), aneuploidy screens and diagnostic genetic procedures. RESULTS The number of patients undergoing first-trimester ultrasound remained similar with the second protocol but decreased in the third (68.7% vs. 40.9%, OR 0.32, 95% CI 0.25-0.4, p < 0.001). Diagnostic procedures decreased between protocol 1 and 2 (7.6% vs. 4.4%, OR 0.59, 95% CI 0.37-0.93, p = 0.02) while NT scans decreased between protocol 2 and 3 (6.8% vs. 1.3%, OR 0.18, 95% CI 0.09-0.4, p < 0.001). The rate of FTS decreased over the study period and less women had cfDNA when they had to choose one method (p < 0.001). CONCLUSIONS Introducing cfDNA screening as an alternative to FTS, resulted in fewer patients receiving ultrasound in the first-trimester.
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Affiliation(s)
- Georgios Doulaveris
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Catherine M Igel
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Fatima Estrada Trejo
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Desiree Fiorentino
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sara Rabin-Havt
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Susan Klugman
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Pe'er Dar
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Pavan L, Gasser B, Maronezi MC, da Cruz ICK, Carneiro RK, Silva P, Ramirez Uscategui RA, Padilha-Nakaghi LC, Feliciano MAR. Ultrasonography of the nuchal translucency of healthy and abnormal English Bulldog fetuses. Anim Reprod 2021; 18:e20210023. [PMID: 34925557 PMCID: PMC8677348 DOI: 10.1590/1984-3143-ar2021-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to measure the nuchal translucency (NT) of canine fetuses to establish reference values for healthy gestational processes and to verify its effectiveness in the diagnosis of congenital abnormalities. On day 34 of gestation, the NT of three fetuses from each of the 26 English bulldog female dogs was measured. The first fetus was the one located immediately cranial to the bladder, the second was selected from the left side of the abdomen, and the third from the right side. The reference values for healthy animals were offset using descriptive statistics. The diagnostic ability of the test to identify fetal malformations was studied using receiver operating characteristic curve analysis. Of the 26 litters, only 18 had healthy fetuses, 4 had fetuses with anasarca, 3 had fetuses with abdominal wall defects, and 1 had both types of abnormalities. The NT was higher in canine fetuses that presented anasarca in the litter than in normal litters (1.8 ± 0.77 mm vs. 1.4 ± 0.48 mm; P = 0.0249), with a cut-off value of NT > 1.45 mm (sensitivity = 61.54%, specificity = 70.18%). NT greater than 1.45 mm seems to be a diagnostic tool for the identification of anasarca during gestation of bulldogs. Considering the unprecedented use of this parameter in canine species and the limitations found during the study, further studies will be needed in order to use it on clinical practice.
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Affiliation(s)
- Letícia Pavan
- Departamento de Reprodução Animal, Universidade Estadual Paulista, Jaboticabal, SP, Brasil
| | - Beatriz Gasser
- Departamento de Reprodução Animal, Universidade Estadual Paulista, Jaboticabal, SP, Brasil
| | | | | | | | - Priscila Silva
- Departamento de Reprodução Animal, Universidade Estadual Paulista, Jaboticabal, SP, Brasil
| | | | | | - Marcus Antônio Rossi Feliciano
- Departamento de Reprodução Animal, Universidade Estadual Paulista, Jaboticabal, SP, Brasil.,Departamento de Clínica de Grandes Animais, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
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Effect of anti-epileptic drugs on first trimester screening test results. Taiwan J Obstet Gynecol 2021; 59:835-837. [PMID: 33218397 DOI: 10.1016/j.tjog.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate first trimester screening test parameters in epileptic patients using anti-epileptic drugs. MATERIALS AND METHODS We retrospectively evaluated first trimester screening test results of 23 epileptic pregnant women using anti-epileptic drugs with a control group consisting of 92 healthy pregnancies. The anti-epileptic drugs used in this study were carbamazepine, levatiracetam, valproic acid and lamotrigine. Single drug or multi-drug regimens were used according to the clinical conditions. Patients with any known chronic or acute disease and drug usage were excluded from the study. Comparisons were performed via Mann-Whitney U test. RESULTS First trimester screening test biochemical markers were compared and maternal serum PAPP-A MoM values were found to be similar in study and control groups while β-hCG MoM values were significantly higher in pregnancies using epileptic drugs (p: 0,737 and p < 0.001, respectively). CONCLUSION Biochemical first trimester screening test results may be affected by anti-epileptic drug usage, which may lead to misinterpretation of the risk level. Thus, validation of MoM values should be necessary in order to obtain optimal results.
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Yulia A, Napolitano R, Aiman A, Desai D, Johal N, Whitten M, Ushakov F, Pandya PP, Winyard PJD. Perinatal and infant outcome of fetuses with prenatally diagnosed hyperechogenic kidneys. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:953-958. [PMID: 32530118 DOI: 10.1002/uog.22121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/18/2020] [Accepted: 05/29/2020] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Hyperechogenic kidneys are a relatively rare antenatal finding, which can generate significant parental anxiety due to uncertain prognosis. We report on the perinatal and infant outcomes of a large cohort of fetuses with antenatally diagnosed hyperechogenic kidneys. METHODS This was a retrospective analysis of all cases diagnosed prenatally with hyperechogenic kidneys between 2002 and 2017 in a large tertiary fetal medicine unit. Hyperechogenicity was defined as kidney parenchyma with greater echogenicity than that of the liver. Pregnancy, pathological and postnatal outcomes were collected from hospital and general practitioner records up to 1 year of age. Abnormal renal outcome was defined as elevated creatinine beyond 6 months of age, hypertension requiring medication or major kidney surgery, such as nephrectomy. Severe abnormal renal outcome was defined as the need for dialysis or kidney transplant at any stage. RESULTS Three-hundred and sixteen fetuses with hyperechogenic kidneys were identified at a mean gestational age of 21 (range, 13-37) weeks. The majority of cases (97%) had bilateral hyperechogenic kidneys. In the 265 cases with available follow-up data, other associated renal tract abnormalities were identified prenatally in 36%, concomitant extrarenal structural abnormalities in 39% and abnormal karyotype in 15% of cases. Of the 316 included cases, 139 did not survive, including 105 terminations of pregnancy, five intrauterine deaths and 29 early neonatal deaths. Only 4.3% (6/139) of these fetuses had isolated hyperechogenic kidneys while 28.1% (39/139) had associated multiple renal tract abnormalities alongside hyperechogenic kidneys and over two-thirds (67.6%; 94/139) had concomitant extrarenal abnormalities. Of the 177 cases that survived beyond 1 month of age, outcome data were available in 126. Of these, based on the antenatal findings, 60 (47.6%) cases had isolated hyperechogenic kidneys, 56 (44.4%) had associated renal structural abnormalities and 10 (7.9%) had additional extrarenal abnormalities. Considering renal outcome alone, kidney function was abnormal in 13 (21.7%), 10 (17.9%) and 0 (0%) infants in these three groups, respectively, although concurrent pathology clearly affected global outcome in the more complex cases. Neonatal mortality of 1.6% was observed in the isolated renal hyperechogenicity group. The presence of oligohydramnios or abnormal renal volume was not associated significantly with abnormal renal function (odds ratio (OR), 2.32 (99% CI, 0.54-10.02) and OR, 0.74 (99% CI, 0.21-2.59), respectively) in this group. CONCLUSIONS Hyperechogenic kidneys are often complicated by associated renal tract and extrarenal abnormalities, aberrant karyotype and genetic disease, and these factors have a greater effect on overall outcome than does kidney echogenicity. The renal outcome of fetuses with isolated hyperechogenic kidneys is good generally, with over 70% of cases having normal renal function postpartum. Importantly, for prognostic counseling, all of the fetuses in this non-selected series with isolated hyperechogenic kidneys and normal amniotic fluid levels had normal renal outcome in infancy. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Yulia
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - R Napolitano
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - A Aiman
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - D Desai
- Urology Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - N Johal
- Urology Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - M Whitten
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - F Ushakov
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - P P Pandya
- Fetal Medicine Unit, University College London Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - P J D Winyard
- Nephro-Urology Group, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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Dinç G, Eyüboğlu İ. Distribution of nuchal translucency thickness at 11 to 14 weeks of gestation in a normal Turkish population. Turk J Med Sci 2021; 51:90-94. [PMID: 32777901 PMCID: PMC7991852 DOI: 10.3906/sag-2001-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background/aim The aim of this study was to determine fetal nuchal translucency (NT) thickness nomogram values in first trimester in a Turkish population and compare them with previously reported European and Asian nomogram data. Material and methods Ultrasonographic measurements of crown-rump length (CRL) and NT thicknesses were obtained from 11 to 14 weeks of gestation in a normal Turkish population. Pregnant women with singleton pregnancy and fetal CRL between 45 and 84 mm were included in the study. The mean 1st, 3rd, 5th, 50th, 90th, 95th, 97th, and 99th percentiles and fixed cut off values of ≥ 2.5 mm, ≥ 3 mm, ≥ 3.5 mm NT thicknesses for a CRL between 45 and 84 mm were determined. Results A total of 1605 healthy fetuses were enrolled in the study. The sonographic measurements were performed on 1541 (%94) fetuses transabdominally and on 99 cases (%4) by the transvaginal route. The mean NT thickness for CRL between 45 and 84 mm was 1.57 ± 074 mm, and the mean 95th, 97th, and 99th percentiles of these values were 2.82 mm, 3.17, and 4.75 mm, respectively. The incidence of NT thicknesses at fixed points of ≥ 2.5 mm, ≥ 3 mm, and ≥ 3.5 mm in normal fetuses were 6.7%, 4.1%, and 2.1%, respectively. Conclusion The present study demonstrated the nomogram data of fetal NT thickness in a Turkish population. We think that this report will be useful for further research related to NT thickness values on the prenatal diagnosis for the first trimester chromosomal abnormalities in Turkish populations.
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Affiliation(s)
- Gülseren Dinç
- Department of Obstetrics and Gynecology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - İlker Eyüboğlu
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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15
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Volpe N, Dall'Asta A, Di Pasquo E, Frusca T, Ghi T. First-trimester fetal neurosonography: technique and diagnostic potential. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:204-214. [PMID: 33049801 DOI: 10.1002/uog.23149] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Most brain abnormalities are present in the first trimester, but only a few are detected so early in gestation. According to current recommendations for first-trimester ultrasound, the fetal head structures that should be visualized are limited to the cranial bones, the midline falx and the choroid-plexus-filled ventricles. Using this basic approach, almost all cases of acrania, alobar holoprosencephaly and cephalocele are detected. However, the majority of other fetal brain abnormalities remain undiagnosed until the midtrimester. Such anomalies would be potentially detectable if the sonographic study were to be extended to include additional anatomic details not currently included in existing guidelines. The aim of this review article is to describe how best to assess the normal fetal brain by first-trimester expert multiplanar neurosonography and to demonstrate the early sonographic findings that characterize some major fetal brain abnormalities. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - E Di Pasquo
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Pregnancy and early post-natal outcomes of fetuses with functionally univentricular heart in a low-and-middle-income country. Cardiol Young 2020; 30:1844-1850. [PMID: 32959750 DOI: 10.1017/s1047951120002929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Care of children with functionally univentricular hearts is resource-intensive. OBJECTIVES To analyse pregnancy and early post-natal outcomes of fetuses with functionally univentricular hearts in the setting of a low-middle-income country. METHODS A retrospective study was conducted during the period of January 2008-October 2019. Study variables analysed included gestational age at diagnosis, maternal and fetal comorbidities and cardiac diagnosis including morphologic type of single ventricle. Outcomes analysed included pregnancy outcomes, type of post-natal care and survival status on the last follow-up. RESULTS A total of 504 fetuses were included. Mean maternal age was 27.5 ± 4.8 years and mean gestational age at diagnosis was 25.6 ± 5.7 weeks. Pregnancy outcomes included non-continued pregnancies (54%), live births (42.7%) and loss to follow-up (3.3%). Gestational age at diagnosis was the only factor that impacted pregnancy outcomes (non-continued pregnancies 22.5 ± 3.5 vs. live births 29.7 ± 5.7 weeks; p < 0.001). Of the 215 live births, intention-to-treat was reported in 119 (55.3%) cases; of these 103 (86.6%) underwent cardiac procedures. Seventy-nine patients (36.7%) opted for comfort care. On follow-up (median 10 (1-120) months), 106 patients (21%) were alive. Parental choice of intention-to-.treat or comfort care was the only factor that impacted survival on follow-up. CONCLUSIONS Prenatal diagnosis of functionally univentricular hearts was associated with overall low survival status on follow-up due to parental decisions on not to continue pregnancy or non-intention-to-treat after birth. Early detection of these complex defects by improved prenatal screening can enhance parental options and reduce resource impact in low-and-middle-income countries.
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Abstract
Prenatal testing for chromosomal abnormalities is designed to provide an accurate assessment of a patient's risk of carrying a fetus with a chromosomal disorder. A wide variety of prenatal screening and diagnostic tests are available; each offers varying levels of information and performance, and each has relative advantages and limitations. When considering screening test characteristics, no one test is superior in all circumstances, which results in the need for nuanced, patient-centered counseling from the obstetric care professional and complex decision making by the patient. Each patient should be counseled in each pregnancy about options for testing for fetal chromosomal abnormalities. It is important that obstetric care professionals be prepared to discuss not only the risk of fetal chromosomal abnormalities but also the relative benefits and limitations of the available screening and diagnostic tests. Testing for chromosomal abnormalities should be an informed patient choice based on provision of adequate and accurate information, the patient's clinical context, accessible health care resources, values, interests, and goals. All patients should be offered both screening and diagnostic tests, and all patients have the right to accept or decline testing after counseling.The purpose of this Practice Bulletin is to provide current information regarding the available screening test options available for fetal chromosomal abnormalities and to review their benefits, performance characteristics, and limitations. For information regarding prenatal diagnostic testing for genetic disorders, refer to Practice Bulletin No. 162, Prenatal Diagnostic Testing for Genetic Disorders. For additional information regarding counseling about genetic testing and communicating test results, refer to Committee Opinion No. 693, Counseling About Genetic Testing and Communication of Genetic Test Results. For information regarding carrier screening for genetic conditions, refer to Committee Opinion No. 690, Carrier Screening in the Age of Genomic Medicine and Committee Opinion No. 691, Carrier Screening for Genetic Conditions. This Practice Bulletin has been revised to further clarify methods of screening for fetal chromosomal abnormalities, including expanded information regarding the use of cell-free DNA in all patients regardless of maternal age or baseline risk, and to add guidance related to patient counseling.
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Simpson L, Maturen KE, Feldstein VA, Oliver ER, Poder L, Strachowski LM, Sussman BL, Weber TM, Winter T, Zelop CM, Glanc P. ACR Appropriateness Criteria® Nuchal Translucency Evaluation at 11 to 14 Weeks of Gestation. J Am Coll Radiol 2020; 17:S447-S458. [PMID: 33153556 DOI: 10.1016/j.jacr.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022]
Abstract
A fetus with an increased nuchal translucency at 11 to 14 weeks gestation is at risk for aneuploidy, genetic syndromes, structural anomalies, and intrauterine fetal demise in both single and twin gestations. In addition to referral to genetics for counseling and consideration of diagnostic genetic testing, a detailed anatomic survey and fetal echocardiogram are indicated in the second trimester to screen for congenital malformations and major heart defects. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Lynn Simpson
- Columbia University, New York, New York; American College of Obstetricians and Gynecologists.
| | | | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liina Poder
- University of California San Francisco, San Francisco, California
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York; American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Karadağ C, Yoldemir T, Demircan S, Çalışkan E. The effects of progesterone treatment on nuchal translucency in women with threatened miscarriage. J OBSTET GYNAECOL 2020; 41:601-604. [PMID: 32811232 DOI: 10.1080/01443615.2020.1787361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aims to investigate the effects of progesterone on the possible changes in nuchal translucency (NT) levels for patients diagnosed with threatened miscarriage. The study group was composed of 125 patients diagnosed with threatened miscarriage and taking 400 mg/day micronized orally progesterone at least for two weeks, the control group was composed of 160 healthy pregnant women not taking any progesterone. Crown rump length (CRL) NT thickness, Pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (Beta-HCG) levels of patients were measured for assessment of aneuploidy risk. Both of the groups were divided into four subgroups to determine the relationship between thickness of NT and progesterone use for specific CRL measurements. CRL in the first, second, third and fourth group was 45-55 mm, 55-65 mm, 65-75 mm, 75-84 mm, respectively. The two groups were age and BMI matched. In all groups of CRL there were no significant difference in Mom levels of NT thickness, PAPP-A and free Beta-HCG between the study and control groups. There havent been any relation between NT thickness and progesterone use.IMPACT STATEMENTWhat is already known about this subject? Recently some studies have claimed that progesterone use might have caused atypical blood flow pattern on foetal circulation, which could possibly increase NT. If the NT thickness is affected by the use of progesterone, then the false positive rate of detecting Down Syndrome screening tests would increase.What the results of this study add? In this study we did not found any relation between NT thickness and progesterone use.What the implications are of these findings for clinical practice and/or further research? Using orally progesterone due to threatened miscarriage do not change NT thickness levels. Further studies have to be done with a large number of participants.
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Affiliation(s)
- Cihan Karadağ
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İstanbul, Turkey
| | - Tevfik Yoldemir
- Department of Obsytetrics and Gynecology, Marmara University School of Medicine, İstanbul, Turkey
| | - Sinem Demircan
- Department of Obsytetrics and Gynecology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İstanbul, Turkey
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Van den Hof MC, Smithies M, Nevo O, Oullet A. No. 375-Clinical Practice Guideline on the Use of First Trimester Ultrasound. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:388-395. [PMID: 30784569 DOI: 10.1016/j.jogc.2018.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This guideline reviews the clinical indications for first trimester ultrasound. OUTCOME Proven clinical benefit has been reported from first trimester ultrasound. EVIDENCE A Medline search and bibliography reviews in relevant literature provided the evidence. VALUES Content and recommendations were reviewed by the principal authors and the Diagnostic Imaging Committee of the Society of Obstetricians and Gynaecologists of Canada. Levels of evidence were judged as outlined by the Canadian Task Force on Preventive Health Care. RECOMMENDATIONS
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Lan L, Wu H, She L, Zhang B, He Y, Luo D, Wang H, Zheng Z. Analysis of copy number variation by sequencing in fetuses with nuchal translucency thickening. J Clin Lab Anal 2020; 34:e23347. [PMID: 32342531 PMCID: PMC7439336 DOI: 10.1002/jcla.23347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
Objective Copy number variation sequencing (CNV‐seq) technique was used to analyze the genetic etiology of fetuses with increased nuchal translucency (NT). Methods A total of 139 women with gestational 11‐14 weeks whose fetuses were detected with increased NT (NT ≥ 2.5 mm) in our hospital from July 2016 to December 2018 were selected. Fetal specimens were performed for karyotyping analysis and CNV sequencing. Results According to the nuchal translucency thickness, 2.5‐3.4, 3.5‐4.4, 4.5‐5.4, and more than 5.5 mm, the rates of chromosomal abnormalities were 22.8% (13/57), 30.8% (12/39), 42.1% (8/19), and 62.5% (15/24), respectively. There was significant difference among the incidences of chromosomal abnormalities in four groups (χ2 = 37.69, P < .01) and the incidences increased with fetal NT thickness. Among 139 cases, there were 36 cases (25.9%) with abnormal chromosome karyotypes. Meanwhile, there were 45 cases (32.3%) with abnormal CNV. In the 12 cases with abnormal CNV and normal chromosome karyotypes, there were 2 cases of pathogenic CNV, 7 cases of CNV with unknown clinical significance, and 3 cases of possibly benign CNV. There was no significant difference in CNV between pregnant women in advanced maternal age and those in normal maternal age (χ2 = 1.389, P = .239). In the fetus who showed abnormalities in NT and ultrasonography (χ2 = 5.13, P < .05) and the fetus aborted (χ2 = 113.19, P < .05), the abnormal rate of CNV was higher with statistically significant difference. Conclusion CNV‐seq combined karyotype analysis should be performed simultaneously in fetuses with increased NT, providing a basis for genetic counseling, which is of great significance for prenatal diagnosis.
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Affiliation(s)
- Liubing Lan
- Prenatal Diagnosis Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Department of Obstetrics, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Heming Wu
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Lingna She
- Prenatal Diagnosis Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Bosen Zhang
- Prenatal Diagnosis Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Department of Obstetrics, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Yanhong He
- Prenatal Diagnosis Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Department of Obstetrics, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Dandan Luo
- Prenatal Diagnosis Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Department of Obstetrics, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Huaxian Wang
- Prenatal Diagnosis Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Zhiyuan Zheng
- Prenatal Diagnosis Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China.,Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, China
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Xue S, Yan H, Chen J, Li N, Wang J, Liu Y, Zhang H, Li S, Zhang W, Chen D, Chen M. Genetic Examination for Fetuses with Increased Fetal Nuchal Translucency by Genomic Technology. Cytogenet Genome Res 2020; 160:57-62. [PMID: 32036363 DOI: 10.1159/000506095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 01/23/2023] Open
Abstract
This study aims to investigate the value of chromosomal microarray analysis (CMA) and whole exome sequencing (WES) in fetuses with increased nuchal translucency (defined as NT above the 95th centile for the crown-rump length). A total of 374 singleton pregnancies with gestational ages ranging from 11 to 13 + 6 weeks were investigated. Ultrasound displayed increased NT and no detectable structural malformations in these fetuses. Pregnancies were divided into 4 groups according to the NT values: 95th centile-3.4 mm (114 cases); 3.5-4.4 mm (150 cases); 4.5-5.4 mm (55 cases); and ≥5.5 mm (55 cases). The possible chromosomal anomalies were all analyzed by CMA first. Furthermore, 24 cases with increased NT but negative CMA results were investigated by WES, and the outcomes were followed up. Among all the 374 cases, causative genetic defects were detected in 100/374 (26.7%) of the cases along with 9 variants of unknown significance (VOUS) by CMA. CMA testing yielded 30 pathogenic variants (30/55), accounting for a detection rate of 54.5%, and 1 VOUS in the group of NT ≥5.5 mm, indicating the highest detection rate in the 4 groups. The 24 cases of the CMA negative sub-cohort with WES analysis further yielded 2 VOUS and 3 likely pathogenic variants, including 2 dominant de novo mutations in SOS1 and ECE1 and 1 recessive inherited compound heterozygous mutation in PIGN, which are associated with cardiac defects. All 3 cases opted for termination of pregnancy (TOP). In addition, 2 cases with increased NT were negative by both CMA and WES analysis, and fetal demise occurred. In conclusion, for the investigation of fetuses with increased NT exome sequencing is suggested to be considered in cases with negative CMA findings. However, appropriate genetic counseling should be given to optimizing its utilization in prenatal diagnosis.
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Wang Q, Wang X, Wu Q. Relationship between first trimester nuchal septations and chromosomal anomalies. Clin Imaging 2019; 60:1-4. [PMID: 31864193 DOI: 10.1016/j.clinimag.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aimed to evaluate the association of nuchal septations with chromosomal anomalies during the first trimester of pregnancy. METHODS A total of 281 patients who were diagnosed to have elevated nuchal translucency (NT > 3 mm) or nuchal septations during the first trimester from Jan. 2014 to Dec. 2016 were included. These patients were divided into three groups: 1) patients with NT thickness between 3 and 5 mm and without nuchal septations (NT 3-5 mm group, n = 124), 2) patients with NT thickness > 5 mm and without nuchal septations (NT > 5 mm group, n = 96), and 3) patients with nuchal septations (NS group, n = 61). RESULTS The rate of chromosomal abnormalities was significantly higher for patients in NS group compared to those in the NT 3-5 mm group (P < .01) and NT > 5 mm group (P < .01). After controlling for maternal age, maternal BMI, ethnicity and crown-rump length, nuchal septations were reported to be significantly associated with a higher risk of chromosomal anomalies compared with NT 3-5 mm (OR = 4.97; 95% CI: 2.76-10.77; P < .01) and NT > 5 mm (OR = 3.82; 95% CI: 1.87-7.21; P < .01) (P < .01). CONCLUSIONS Measurement of nuchal septations during the first trimester of pregnancy proves to be a useful ultrasound prognostic indicator of chromosomal anomalies.
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Affiliation(s)
- Qing Wang
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Xin Wang
- Department of Perinatal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
| | - Qingqing Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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24
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Van den Hof MC, Smithies M, Nevo O, Ouellet A. No 375 – Directive clinique sur l'utilisation de l’échographie au premier trimestre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:396-404. [DOI: 10.1016/j.jogc.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Grossman TB, Bodenlos KL, Chasen ST. Abnormal nuchal translucency: residual risk with normal cell-free DNA screening. J Matern Fetal Neonatal Med 2019; 33:3062-3067. [PMID: 30669906 DOI: 10.1080/14767058.2019.1568405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To determine the proportion of genetic abnormalities that could be identified by cell-free DNA screening in pregnancies with an abnormal nuchal translucency.Methods: From 2015-2017, pregnancies with nuchal translucency ≥ 3.0 mm on ultrasounds were identified. Pregnancies with genetic testing results were included, whether or not cell-free DNA screening was performed. Comparisons of the proportion of genetic abnormalities detectable on cell-free DNA screening versus not detectable were made based on nuchal translucency values (3.0-3.4 mm; ≥3.5 mm) and maternal age (≥35 versus <35 years). Chi-square analysis, Fisher's exact test, and Mann-Whitney U were used for statistical comparison.Results: One hundred ten patients were included, 60 had genetic abnormalities (54.5%), with 44 (73.3%) detectable on cell-free DNA screening and 16 (26.7%) not. In those with nuchal translucency ≥3.5 mm, only 40 of 56 (71.4%) of abnormalities could be detected by cell-free DNA screening. Cell-free DNA screening could identify 27 of 31 abnormalities with nuchal translucency ≥3.5 mm in women ≥35 years but could identify only 13 of 25 genetic abnormalities in younger women (87.1 versus 52.0%; p = .005).Conclusion: A significant proportion of abnormalities in those with nuchal translucency ≥3.5 mm would not be detected by cell-free DNA, especially in younger women.
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Affiliation(s)
- Tracy B Grossman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kimberly L Bodenlos
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Stephen T Chasen
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Weill Cornell Medical College, New York, NY, USA
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Hunter LE, Seale AN. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease. Echo Res Pract 2018; 5:R81-R100. [PMID: 30012852 PMCID: PMC6107762 DOI: 10.1530/erp-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
This review article will guide the reader through the background of prenatal screening for congenital heart disease. The reader will be given insight into the normal screening views, common abnormalities, risk stratification of lesions and also recent advances in prenatal cardiology.
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Affiliation(s)
- Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children’s Hospital, Birmingham, UK
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27
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Advani HV, Barrett AN, Evans MI, Choolani M. Challenges in non-invasive prenatal screening for sub-chromosomal copy number variations using cell-free DNA. Prenat Diagn 2017; 37:1067-1075. [PMID: 28950403 DOI: 10.1002/pd.5161] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/23/2017] [Accepted: 09/16/2017] [Indexed: 12/14/2022]
Abstract
Non-invasive prenatal screening (NIPS) has revolutionized the approach to prenatal fetal aneuploidy screening. Many commercial providers now offer analyses for sub-chromosomal copy number variations (CNVs). Here, we review the use of NIPS in the context of screening for microdeletions and microduplications, issues surrounding the choice of disorders tested for, and the advantages and disadvantages associated with the inclusion of microdeletions to current NIPS. Several studies have claimed benefits; however, we suggest that microdeletions have not demonstrated a low enough false positive rate to be deemed practical or ethically acceptable, especially considering their low positive predictive values. Because a positive NIPS result should be confirmed using diagnostic techniques, and false positive rates are as high as 90% for some microdeletions, diagnostic testing seems preferable when the goal is to maximize the detection of microdeletion or microduplication syndromes.
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Affiliation(s)
- Henna V Advani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Angela N Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark I Evans
- Department of Obstetrics and Gynecology, Mt. Sinai School of Medicine, New York, NY, USA.,Comprehensive Genetics and Fetal Medicine Foundation of America, New York, NY, USA
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Socolov D, Socolov R, Gorduza VE, Butureanu T, Stanculescu R, Carauleanu A, Pavaleanu I. Increased nuchal translucency in fetuses with a normal karyotype-diagnosis and management: An observational study. Medicine (Baltimore) 2017; 96:e7521. [PMID: 28723764 PMCID: PMC5521904 DOI: 10.1097/md.0000000000007521] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The use of nuchal translucency (NT) in 1992 by Nicolaides et al was a major breakthrough in screening for chromosomal aneuploidies at the end of the first trimester. However, pathological conditions other than chromosomal aneuploidies are also associated with increased NT, which can also be detected in normal fetuses. This study sought to evaluate the causes of this ultrasound sign in a group of patients from Iasi, Romania.During the decade-long study period, there were 71 certified cases involving increased NT; the patients in these cases underwent diagnostic amniocentesis and karyotyping.In most of the examined cases (55 cases, 78%), there was no aneuploidy. The remaining cases involved trisomy 21 (T21) (18%), trisomy 18 (T18) (2%), or triploidy (2%). In most cases, the indication for amniocentesis was increased NT alone (81%), whereas the remaining cases also involved advanced maternal age (5.5%), abnormal serologic markers (10%), or other ultrasound signs (3.5%) (2 cases-cardiac anomalies and fetal hydrops). A favorable pregnancy outcome at term was achieved in 40 cases (56% from total, 72% from euploid pregnancies); kidney anomalies or nonlethal cardiac conditions were observed in 12 cases (17%), 6 of which involved complications associated with premature onset of labor, and miscarriages occurred in 6 cases. Three cases were lost at follow-up.Although it is common practice to assume that increased NT is an indication for amniocentesis, both literature results and our study findings indicate that the majority of cases with increased NT involve no aneuploidy and result in a favorable outcome if no other anomaly is present. Better evidence-based management of such cases could be promoted by conducting larger, multicenter studies, and following cases for longer periods.
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Affiliation(s)
- Demetra Socolov
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
| | - Razvan Socolov
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
- Hospital of Obstetrics and Gynecology Elena Doamna-Iasi
| | | | - Tudor Butureanu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
| | | | - Alexandru Carauleanu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
| | - Ioana Pavaleanu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
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Ali MM, Chasen ST, Norton ME. Testing for Noonan syndrome after increased nuchal translucency. Prenat Diagn 2017; 37:750-753. [PMID: 28569377 DOI: 10.1002/pd.5076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/19/2017] [Accepted: 05/26/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to report the prevalence of Noonan syndrome (NS) in a cohort of fetuses that presented with increased nuchal translucency (NT) thickness in the first trimester of pregnancy. METHODS This is a retrospective chart review. INCLUSION CRITERIA (1) first trimester NT measurement ≥3 mm, (2) normal karyotype by either a CVS or an amniocentesis procedure, and (3) prenatal molecular genetic testing for NS completed. Results with known pathogenic variants were considered positive, while those with variants of unknown clinical significance, or with no variants, were considered negative. RESULTS A total of 804 fetuses had an NT measurement of ≥3 mm, with a median NT thickness of 3.6 mm. Of these, 302 had karyotyping by CVS or amniocentesis, 200 (66.23%) with normal results. Of fetuses with a normal karyotype, 39 with a median NT thickness of 4.0 mm had a NS gene sequencing panel done, and 161 fetuses with a mean NT thickness of 4.3 mm were not tested for NS (p = 0.05). Of the 39 fetuses who were tested for NS, four (10.3%) had variants consistent with this diagnosis. CONCLUSION In euploid fetuses, increased NT is associated with a 10% risk of NS. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marwan M Ali
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Stephen T Chasen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Mary E Norton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA
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Yılmaz ZV, Türkmen GG, Yılmaz E, Dağlar K, Kırbaş A, Sanhal C, Yücel A, Uygur D. Influence of Behçet's disease on first and second trimester serum screening markers. J Obstet Gynaecol Res 2016; 43:511-515. [DOI: 10.1111/jog.13237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Zehra Vural Yılmaz
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | | | - Elif Yılmaz
- Department of Obstetrics and Gynaecology; Dr. Sami Ulus Women's and Children's Health Training and Research Hospital; Ankara Turkey
| | - Korkut Dağlar
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Ayşe Kırbaş
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Cem Sanhal
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Aykan Yücel
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
| | - Dilek Uygur
- Department of Perinatology; Zekai Tahir Burak Women's Health Education and Training Hospital; Ankara Turkey
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Kose S, Cımrın D, Yıldırım N, Aksel O, Keskinoglu P, Bora E, Cankaya T, Altunyurt S. Analysis of first-trimester combined test results in preparation for a cell-free fetal DNA era. Int J Gynaecol Obstet 2016; 135:187-191. [PMID: 27569022 DOI: 10.1016/j.ijgo.2016.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/23/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To survey experience with the first-trimester combined test (FCT) for trisomy 21 (T21) in different risk score groups to determine the most useful clinical application of cell-free fetal DNA (cffDNA) screening. METHODS In a retrospective study, the records of FCT results obtained at a center in Turkey between January 2009 and January 2014 were reviewed. The FCT results and rates of uptake of invasive diagnostic testing were compared among different risk score groups. RESULTS FCT results were available for 4804 pregnancies; 276 (5.7%) had IDT results. Ten (72.7%) of 11 cases of T21 had a risk score of 1:300 or more. The IDT uptake rates were 54.5%, 51.9%, and 47.4% at risk scores of 1:100 or more, 1:200 or more, and 1:300 or more, respectively. In the group at intermediate risk (1:1001-1:3000), no pregnancy had an FCT result of both low pregnancy-associated plasma protein A and high free β-human chorionic gonadotropin, but 30 (3.9%) of 766 pregnancies had both advanced maternal age and high β-human chorionic gonadotropin. CONCLUSION cffDNA screening should be used to optimize IDT uptake in pregnancies with a risk score of 1:101-1:1000. The selective power of the FCT diminishes beyond the 1:1001 score and cffDNA screening cannot yet be recommended routinely.
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Affiliation(s)
- Semir Kose
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey.
| | - Dilek Cımrın
- Central Clinical Laboratory, University Hospital, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Nuri Yıldırım
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Ozge Aksel
- Department of Medical Genetics, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Pembe Keskinoglu
- Department of Biostatistics, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Elcin Bora
- Department of Medical Genetics, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Tufan Cankaya
- Department of Medical Genetics, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
| | - Sabahattin Altunyurt
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Balcova, Izmir, Turkey
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Yang X, Li R, Fu F, Zhang Y, Li D, Liao C. Submicroscopic chromosomal abnormalities in fetuses with increased nuchal translucency and normal karyotype. J Matern Fetal Neonatal Med 2016; 30:194-198. [DOI: 10.3109/14767058.2016.1168394] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Liao KW, Tsai MS, Chang CH, Chien LC, Mao IF, Tsai YA, Chen ML. Do the Levels of Maternal Plasma Trace Elements Affect Fetal Nuchal Translucency Thickness? PLoS One 2015; 10:e0138145. [PMID: 26367380 PMCID: PMC4569564 DOI: 10.1371/journal.pone.0138145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Fetal nuchal translucency (NT) thickness is an important marker for prenatal screening; however, studies focusing on the correlation between maternal trace element levels and NT thickness are limited. The aim of this study was to evaluate maternal trace element levels during the first trimester and to investigate the association between maternal trace element levels and fetal NT thickness. METHODS In total, 113 samples were obtained from singleton pregnant women. Maternal plasma samples were collected in the first trimester of gestation. Plasma trace element levels were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Nuchal translucency thickness was measured using ultrasonography at 10-14 weeks of gestation. RESULTS We found that maternal plasma potassium (K) levels had a significant negative correlation with both NT (r = -0.230, p < 0.05) and NT Multiples of the Median (NT MoM) (r = -0.206, p < 0.05). After adjustment for potential confounders, log-transformed maternal plasma potassium levels in the first trimester were significantly associated with fetal NT (NT MoM: β = -0.68, p < 0.05; NT: β = -1.20, p < 0.01). Although not statistically significant, the As, Hg and Pb levels in maternal plasma were positively correlated with NT, and the Mg, Cu, Zn, Na and Ca levels were negatively correlated with NT. CONCLUSION Maternal plasma K levels during the first trimester appeared to be associated with NT thickness. The essential elements tended to decrease NT thickness, and non-essential elements tended to increase it.
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Affiliation(s)
- Kai-Wei Liao
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ming-Song Tsai
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Huang Chang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ling-Chu Chien
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - I-Fang Mao
- Department of Occupational Safety and Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-An Tsai
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Mei-Lien Chen
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
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Skutilova V. Knowledge, attitudes and decision-making in Czech women with atypical results of prenatal screening tests for the most common chromosomal and morphological congenital defects in the fetus: Selected questionnaire results. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:156-62. [DOI: 10.5507/bp.2013.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 06/06/2013] [Indexed: 11/23/2022] Open
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Giorlandino C, Cignini P, Padula F, Giannarelli D, d’Emidio L, Aloisi A, Plotti F, Angioli R. Effects of exogenous progesterone on fetal nuchal translucency: an observational prospective study. Am J Obstet Gynecol 2015; 212:335.e1-7. [PMID: 25305408 DOI: 10.1016/j.ajog.2014.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/21/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Nuchal translucency (NT) seen ultrasonographically at 11-14 weeks' gestation is a sensitive marker for Down syndrome. Despite its important role for Down syndrome screening, its use is still considered controversial due to high false-positive rates. We speculated that progesterone could lead to abnormal blood flow patterns and, subsequently, to increased NT. Our primary endpoint was to evaluate the effects of exogenous progesterone on NT thickness compared to controls. The secondary endpoint was to evaluate these effects in a subgroup at low risk for fetal aneuploidies, identifying the strongest factors influencing NT variation. The tertiary endpoint was to evaluate, within the treatment group, if there is any difference in NT according to the type of progesterone administered, route of administration, and dose regimen. STUDY DESIGN All women who came to measure NT at 11-14 weeks' gestation (crown-rump length between 45-84 mm) were considered eligible. We divided patients into 2 groups: women receiving exogenous progesterone and controls. Afterwards, 3 NT scans were performed for each case, and the largest value, accurate to 2 decimal points, was recorded. RESULTS In all, 3716 women were enrolled and analyzed. In a crude analysis, NT (P < .05) increased in the exogenous progesterone group. The same results were obtained in the low-risk group (P < .05). The factorial analysis of variance model confirmed a correlation between altered NT and gestational age (P < .0001) and progesterone exposure (P < .05). The characteristics of treatment (route, formulation, dose) were examined separately and no statistically significant differences among the subgroups were observed. CONCLUSION Exogenous progesterone increases NT.
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Antenatal counselling for congenital anomaly tests: An exploratory video-observational study about client–midwife communication. Midwifery 2015; 31:37-46. [DOI: 10.1016/j.midw.2014.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/10/2014] [Accepted: 05/04/2014] [Indexed: 01/22/2023]
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Kyeong KS, Yeon H, Jeong EH. Increased Nuchal Translucency and Early Growth Retardation Related to Confined Placental Mosaicism of Trisomy 16 in a Dichorionic Twin. Fetal Pediatr Pathol 2015. [PMID: 26207568 DOI: 10.3109/15513815.2015.1068415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Confined placental mosaicism (CPM) of trisomy 16 is related to intrauterine growth restriction; however, its association with increased nuchal translucency (NT) has not been sufficiently studied. We report the first case involving a diagnosis of CPM for trisomy 16 in a dichorionic twin. Increased NT (3.7 mm) and 1 week of growth retardation at 12 weeks of gestational age were detected in the affected fetus compared with the normal fetus. Given that the biochemical analytes in maternal serum aneuploidy screening of the abnormal fetus were diluted by the presence of the normal fetus, this method was unreliable as a screening tool. Therefore, in dichorionic twins, ultrasonographic findings such as increased NT and early growth retardation can serve as important indicators for the diagnosis of CPM of trisomy 16.
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Affiliation(s)
- Kyu-Sang Kyeong
- a Chungbuk National University Hospital, Chungbuk National University College of Medicine , Obstetrics and Gynecology , Cheongju , Republic of Korea
| | - Hyeonkyeong Yeon
- a Chungbuk National University Hospital, Chungbuk National University College of Medicine , Obstetrics and Gynecology , Cheongju , Republic of Korea
| | - Eun-Hwan Jeong
- a Chungbuk National University Hospital, Chungbuk National University College of Medicine , Obstetrics and Gynecology , Cheongju , Republic of Korea
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The Detection Rate of Cardiac Anomalies at 11–13+6 Week Scan Using Four Chamber View and Three Vessel View. JOURNAL OF FETAL MEDICINE 2014. [DOI: 10.1007/s40556-014-0012-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Allaf MB, Campbell WA, Vintzileos AM, Haeri S, Javadian P, Shamshirsaz AA, Ogburn P, Figueroa R, Wax J, Markenson G, Chavez MR, Ravangard SF, Ruano R, Sangi-Haghpeykar H, Salmanian B, Meyer M, Johnson J, Ozhand A, Davis S, Borgida A, Belfort MA, Shamshirsaz AA. Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1573-1578. [PMID: 25154937 DOI: 10.7863/ultra.33.9.1573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second-trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes. METHODS We conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16- to 18-week sonographic examination who had serial follow-up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16- to 18-week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin-twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20% difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5-minute Apgar score less than 7, necrotizing enterocolitis, culture-proven early-onset sepsis, and neonatal death. Receiver operating characteristic and logistic regression-with-generalized estimating equation analyses were constructed. RESULTS Among the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79% and 80%, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin-twin transfusion syndrome or adverse neonatal outcomes. CONCLUSIONS In our cohort, only second-trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin-twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.
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Affiliation(s)
- M Baraa Allaf
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Winston A Campbell
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Anthony M Vintzileos
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Sina Haeri
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Pouya Javadian
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Amir A Shamshirsaz
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Paul Ogburn
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Reinaldo Figueroa
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Joseph Wax
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Glenn Markenson
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Martin R Chavez
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Samadh F Ravangard
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Bahram Salmanian
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Marjorie Meyer
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Jeffery Johnson
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Ali Ozhand
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Sarah Davis
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Adam Borgida
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.)
| | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.).
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Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129:2183-242. [PMID: 24763516 DOI: 10.1161/01.cir.0000437597.44550.5d] [Citation(s) in RCA: 719] [Impact Index Per Article: 71.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin-twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. CONCLUSIONS Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.
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The role of fetal echocardiography in the assessment of fetal aneuploidy. Clin Obstet Gynecol 2014; 57:189-209. [PMID: 24488057 DOI: 10.1097/grf.0000000000000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in both imaging technology and understanding of fetal cardiac disease have contributed to a dramatic increase in the sensitivity and specificity of fetal echocardiography over the last few decades. Fetal echocardiography now plays an important role in the prenatal evaluation of fetuses with known or suspected aneuploidy. In this article, specific situations in which fetal echocardiography has a part in noninvasive aneuploidy screening algorithms are discussed.
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Elsayed GM, El Assiouty L, El Sobky ES. The importance of rapid aneuploidy screening and prenatal diagnosis in the detection of numerical chromosomal abnormalities. SPRINGERPLUS 2013; 2:490. [PMID: 24156088 PMCID: PMC3798449 DOI: 10.1186/2193-1801-2-490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/25/2013] [Indexed: 11/30/2022]
Abstract
Objectives Evaluation of Fluorescent in situ hybridization (FISH) as a tool for rapid aneuploidy screening (RAS) of high risk pregnancies, before its approval in the national antenatal screening and genetic diagnosis program in Egypt. Methods The cytogenetic data of prenatal specimens, and results of FISH of 100 patients performed between, January 2009 and December 2009, at the Medical Genetics Center (MGC) laboratory were retrieved and reviewed. AneuVysion Assay kit was used for detection of 13, 21, X, Y, 18 aneuploidies. Results Maternal age varied from 21 to 44 years (mean was 35.6 year). Ninety percent of pregnancies had normal chromosomes and 10% of the cases had numerical chromosomal abnormalities. Trisomy 21 was the most frequent chromosomal disorder across all indications (5%), followed by Turner syndrome (2%), trisomy 18 (2%), and trisomy 13 (1%). When comparing the FISH data with karyotype results for chromosomes 13, 18, 21, X, and Y in the 83 individual tested, no false positive or negative results were detected by the FISH assay. The result obtained by FISH and the banding cytogenetic were in complete accordance. Conclusion This study supports the integration of amniotic fluid (AF) FISH as a RAS test, in to routine antenatal practice for identification of chromosome aneuploidies. There are trends towards delayed childbearing and most cases of Down Syndrome (DS) are currently detected post-nataly in the Egyptian population. Consequently, the live birth prevalence of DS has increased, which might lead to a serious negative public health effects.
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Affiliation(s)
- Ghada M Elsayed
- Clinical pathology Department, National cancer institute, Cairo University, Giza, Egypt ; Medical genetics center, 27A Baghdad Street, Korba Cairo, Egypt
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Borrell A, Grande M, Bennasar M, Borobio V, Jimenez JM, Stergiotou I, Martinez JM, Cuckle H. First-trimester detection of major cardiac defects with the use of ductus venosus blood flow. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:51-57. [PMID: 23152003 DOI: 10.1002/uog.12349] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/27/2013] [Accepted: 10/31/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess the best method of combining fetal nuchal translucency (NT) and ductus venosus (DV) blood flow measurements in the detection of major cardiac defects in chromosomally normal fetuses during the first-trimester scan. METHODS During an 8-year period NT and DV blood flow were routinely assessed at 11-14 weeks' gestation. Only chromosomally normal singleton pregnancies were included in the study. When a cardiac defect was suspected, or when increased fetal NT and/or absent or reversed (AR) A-wave in the DV was observed, early fetal echocardiography was offered. Data on routine second- and third-trimester scans, neonatal follow-up or postmortem examination were obtained from hospital records. The detection and false-positive rates for all major cardiac defects were calculated for several screening strategies, including: NT or DV pulsatility index for veins (DV-PIV) above a fixed normal centile; AR A-wave; risk based on NT and DV-PIV or A-wave velocity above a fixed normal centile; and combinations of these strategies. RESULTS The study population included 37 chromosomally normal fetuses with a major cardiac defect and 12 799 unaffected pregnancies. Fetal NT above the 95(th) or the 99(th) centile and AR A-wave was observed in 40, 27 and 39% of the fetuses with major cardiac defects, respectively. A 47% detection rate with a 2.7% false-positive rate was obtained when AR A-wave or NT above the 99(th) centile was used as the selection criterion. CONCLUSIONS Half of major fetal cardiac defects could be detected in the first trimester if NT and DV Doppler are used to select 2.7% of the general pregnant population for extended fetal echocardiography.
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Affiliation(s)
- A Borrell
- Department of Maternal-Fetal Medicine, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic Barcelona, Catalonia, Spain.
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Äyräs O, Tikkanen M, Eronen M, Paavonen J, Stefanovic V. Increased nuchal translucency and pregnancy outcome: a retrospective study of 1063 consecutive singleton pregnancies in a single referral institution. Prenat Diagn 2013; 33:856-62. [DOI: 10.1002/pd.4143] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Outi Äyräs
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Marianne Eronen
- Health Department; The Social Insurance Institution of Finland; Helsinki Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
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Hantoushzadeh S, Tara F, Salmanian B, Gharedaghi MH, Nasri K, Ganjizadeh M, Ghaffari SR, Tahmasebpour AR, Farrokhi B, Abdollahi A, Sheikh M, Javadian P. Correlation of nuchal translucency and thyroxine at 11-13 weeks of gestation. J Matern Fetal Neonatal Med 2013; 26:1586-9. [PMID: 23488768 DOI: 10.3109/14767058.2013.784259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. Here, we investigated the association between NT thickness and thyroid related hormones. METHODS NT thickness was measured with transabdominal ultrasound in 643 pregnant women between 11 and 13 weeks of gestation. Maternal thyroxine (T4), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were evaluated. Bivariate correlations were assessed and thyroid profile was subcategorized with regard to the calculated reference ranges. RESULTS An inverse relation was found between serum levels of maternal T4 with NT thickness (r = -0.128, p = 0.001) and CRL (r = -0.168, p < 0.001). TSH and hCG were also found to be correlated (Spearman's correlation coefficient = -0.092, p = 0.019). Prevalence of maternal hypothyroidism and subclinical hypothyroidism were 1.1% and 3.7%, respectively. CONCLUSION Thyroid function tests are found to independently influence NT measurements in the first trimester. Assessment of hormones such as thyroxine could optimize the interpretation of screening tests for pathological conditions during pregnancy.
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Affiliation(s)
- Sedigheh Hantoushzadeh
- Maternal-Fetal & Neonatal Research Center and Breast Feeding Research Center, Tehran University of Medical Sciences , Tehran , Iran
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Registres de malformations congénitales : un outil pour la surveillance, la recherche et l’évaluation des actions de santé. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2013. [DOI: 10.1016/s0001-4079(19)31588-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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NSGC Practice Guideline: Prenatal Screening and Diagnostic Testing Options for Chromosome Aneuploidy. J Genet Couns 2012. [DOI: 10.1007/s10897-012-9545-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Berktold L, von Kaisenberg CS, V Kaisenberg C, Hillemanns P, Vaske B, Schmidt P. Analysis of the impact of PAPP-A, free β-hCG and nuchal translucency thickness on the advanced first trimester screening. Arch Gynecol Obstet 2012; 287:413-20. [PMID: 23080546 DOI: 10.1007/s00404-012-2585-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 10/01/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The intention of this study is to analyze the impact of the single parameters NT, PAPP-A and free β-hCG used in combined first trimester screening and to determine their contribution in the risk assessment. METHODS A retrospective risk assessment on the advanced first trimester screening (AFS) algorithm was made to determine the effect of a particular parameter while the remaining ones were fixed for calculation. Afterward data were recalculated by the AFS module. Test performance was measured by receiver operating characteristics (ROC) curves and their area under curve (AUC). RESULTS Among the 14,862 cases are 14,748 healthy fetuses, 86 with trisomy 21, 22 with trisomy 18 and 6 with trisomy 13. Some settings obtain at default cut-off a very high sensitivity. However, a lack of specificity, as a high false-positive rate, too. The ROC analysis was best for NT, followed by PAPP-A. Free β-hCG showed the lowest AUC. Combining PAPP-A and free β-hCG offered a better AUC than each parameter alone. Best test performance was obtained by including all three parameters. DISCUSSION A detection rate of 69 % for testing NT discretely is in order with present study data. PAPP-A is following and free β-hCG is not useful with a test positive rate of about a third. The detection rate of the biochemical parameters combined is higher than for NT alone, but results in a five times higher punctuation rate. All parameters together in the AFS provide the best test performance. The impact of each parameter NT, PAPP-A and free-β-hCG in a combined test strategy is nearly a third. Thus, every single parameter is needed to provide a high detection rate for all of the trisomies and minimize the number of unnecessary invasive diagnostics.
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Lelong N, Thieulin AC, Vodovar V, Goffinet F, Khoshnood B. Surveillance épidémiologique et diagnostic prénatal des malformations congénitales en population parisienne : évolution sur 27 ans, 1981–2007. Arch Pediatr 2012; 19:1030-8. [DOI: 10.1016/j.arcped.2012.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 05/23/2012] [Accepted: 06/29/2012] [Indexed: 10/26/2022]
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